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Sunday, March 26, 2017

Let me be clear. I don’t really
think your primary care doctor, who is perhaps an internist/cardiologist (like
mine) or maybe a family care doctor, is being disingenuous when he or she writes
in your file, “patient non-compliant.” They almost certainly, or for the most
part, sincerely believe in the advice they have given you. They advised you how to lose weight (exercise a lot and
eat a calorie-restricted balanced diet), specificallyto eat a “healthy low-fat
diet,” And when you failed to get the results they expected, they concluded it was because you didn’t follow their counsel. So, they deduce, you must have cheated. You were “non-compliant.”

Why do they expect this result, you
ask? Because the Guidelines for Clinical Practice for each of the practice
specialties, and the governing medical associations (the AMA, AHA, ADA, etc.),
all told them to. That is the result of virtually all of the patient cohorts
who were given this advice before you. So, the explanation – the reason – must be that it was the patient who failed to follow it…who was non-compliant. That’s also when
the clinical guidelines tell them to start
you on drugs to accomplish what you
failed to do.

It never occurs to them that it
could be the advice they gave you
that failed to produce the outcome they (and you) desired. The advice to eat a
low saturated fat, low cholesterol diet has now been in place for over half a
century – since the time any doctor in practice today went to medical school.
The advice was first popularized by the publicity given to the treatment of
Eisenhower after his first heart attack in 1955. Before he died 14 years later,
he was to have 7 myocardial infarctions, 14 cardiac arrests, and at least 1
stroke, but never mind….

The advice to eat a low saturated
fat, low cholesterol diet was also strongly espoused by a University of
Wisconsin physiologist, Ancel Keys. The bad science, publicized in his “Six
Country Analysis” (1955), and later compounded in his “Seven Countries Study”
(1958), has since been widely discredited, but
never mind….

By January 1961, Keys was on the
cover of then popular Time magazine
and had been invited to join the Board of The American Heart Association. And to this day the AMA still
espouses a low saturated fat, low cholesterol diet. The evidence that this
advice is faulty – in fact, is
the virtual opposite of the
heart-healthy diet that you should
be eating – has existed from “the beginning.” See this timeline, by Diet Heart Publishing.

The evidence supporting a healthy
diet has now been well documented in the last decade in at least three
thoroughly researched, landmark books: 1) Gary Taubes’s “Good-Calories,
Bad-Calories”; Denise Minger’s, “The Big Fat Surprise”; and Gary Taubes’s new,
“The Case Against Sugar.” There are many others, but these three are the best.
They’re an easier read than the peer-reviewed scientific journals they’re based
upon.

What got me going on this minor
rant was this article in Medscape Medical News last month
that described the efforts of scientists to “reprogram” alpha cells in the
pancreas to regenerate new beta cells in mice. These are the cells that make
insulin until they are destroyed by an autoimmune disorder, as in type 1
diabetes, or they just wear out from overuse due to Insulin Resistance in type
2 diabetes.

What set me off in this article was
the suggestion that a similar advance (an “artificial pancreas”) “may enable
tight glycemic control with minimal
patient intervention” (my emphasis). Great news for type 1s, of course, but
from my perspective (as a type 2) it just reinforces the notion that “minimal
patient intervention” was the only
course of treatment available for type 2s in the clinical setting since
patients are “non-compliant” and fail to achieve the desired outcomes when they follow their doctor’s advice.
THUS, THE PATIENT IS TO BLAME!

But what if you, the patient, took
control of your diet and your metabolic health, and ate a healthy, low carb,
moderate protein, high fat diet, including heart healthy saturated fat, without
concern for dietary cholesterol? What if you did this and the outcome was a big
weight loss and a lab report with an improved lipid panel?

Sunday, March 19, 2017

I’ve changed the
title of the Challenge from “2-month, 20-pound” to “10-Week, 30-Pound.” The
primary reason is that it became clear I was going to over achieve my goal.
This is the new mid-point report.

The second
reason is that I have a doctor’s appointment coming up in Week 11, and I wanted
to capture the best A1c and weight loss improvements possible. The challenges
will be that, for a large part of the final 2½ weeks, the unique circumstances
that gave rise to my beginning this gambit will change: 1) I will not be alone
and preparing all my own meals, and 2) I will at times be “on the road” and
eating most meals in restaurants.

That being said,
the necessary adjustments will be good for me. They will allow me to transition
to “real life” while at the same time being under the gun to preserve
continue the gains. (See how easy it is to undercut one’s confidence and
resolve?) Reference: for the Challenge, see #368,
for the 1st week’s Progress Report, see #370,
and for the 2nd week’s, see #371.
Now, back to the 5th Week (new
mid-point) Progress Report here:

Week 3:
Having gained 1 pound in Week 2 (after losing 11 in Week 1), I was confident
the “progress…was not really lost,” and “it [the progress] will show up on the
scale this coming week.” Well, I lost
4 pounds in Week 3.

Better yet, my Fasting Blood Glucose (FGB) average
also dropped again, from 88mg/dl (3.8mmol/L) to 86 (3.7). The actual
readings were 81, 104, 90, 78, 84, 83 & 79. The 104 was a surprise. It came
after a supper of veal kidneys cooked in onions and mushrooms with Marsala wine
and a salad of Romaine lettuce, mushrooms, hazel nuts, shredded cheese and my
homemade vinaigrette made with white wine vinegar. Go figure! Tonight I’m
having the 2nd half of that kidney preparation, with the same salad,
so we’ll see what happens.

Changes in Week
3: Going forward I’m going to cut my morning coffee from a 16oz mug to a 12oz
mug. That should reduce the heavy cream from 2oz to 1½oz. I found that I had
swallowed all my supplements with only half a cup and the 2nd half
was an indulgence. The idea came to me after reading a blogger who was looking
for people to join him in a 30-day coffee fast. I like coffee, but I am not
addicted to it, and I don’t want to be.

Week 4: Well, it wasn’t the
veal kidney and salad supper that gave me that anomalous 104mg/dl FBG
(5.8mmol/L) last week. The same supper the 2nd time produced a FBG
of 74mg/dl (4.1mmol/L) this morning. Conclusion: anomalies happen. Now, once
again, the big news this week: My FBG average
plummeted again, from 86mg/dl (4.8mmol/L) to 77 (4.3). I haven’t seen FBGs like this ever!
True, on my own initiative, but with the concurrence of my doctor,
about a year ago I increased my dose of Metformin from 500mg/day to 1,500. I
had read somewhere that 1,500mg was considered a “therapeutic” dose. The
inference I drew from that was that a dose of less than 1,500 was not
therapeutic. And since I have been a diagnosed type 2 for 30 years, and on a
reduced dose of 500mg for the last 15 since beginning VLC, it seemed
appropriate to me that my medication should
be therapeutic. But I think
my doctor never suggested an increase because he thinks my diabetes is already
“in good control.” I’m not blaming him. That’s the guidance he gets from the
ADA, Medicare, etc. By the way, in Week 4 I lost 2 more pounds, bringing me
to 16 total in the first 4 weeks.

Week 5: I’m settling into a
groove. My weight dropped by another 2 pounds, bringing the 4 week total to
18. The big surprise this week is that my FBG continues to drop. This week
I had 3 readings in the low 60s, and my FGB average this week dropped
to 70 mg/dl (3.9 mmol/L). Recapping my FBG averages: 119 the week before
starting, then 100, 88, 86, 77 and now 70. I hope they level off now. If not, I’ll cut my Metformin. My goal,
though, is to lower my A1c, so I am willing to have some “low” readings so long
as I feel I am in no danger of hypoglycemia. My sense is that my glucose levels
are stable. I have some concern about the ones in the 60s, but I feel fine and
am unaware of the “lows.” I have tested a few days in the late afternoon, when
historically I have been lowest, and my readings have all been in the mid 70s.
If my FBGs persist in the 60s, particularly after fasting days, I’ll test at
bedtime, and if low, again during the
night when my bladder calls.

Conclusion: I can’t believe
that I have been so blind in my diabetes self-management for these last 15
years!

Sunday, March 12, 2017

When you read this I will be 5 weeks into my “2-month, 20-pound challenge,”
but I write it after 2 weeks “in.”
The first week I lost 11 pounds and lowered my FBG average by 19 points
to 100mg/dl (5.6mmol/L). I did this by strictly following a program of eating 5
Low Carb meals prepared at home by me (2 or more at a time) and then fasting on
Tuesdays and Thursdays. Note that in the first week I did not dine out once, as
I had planned.

This week I report on week 2 of the
challenge. Based on my FBGs this week, I have also revised the terms, to extend
the duration from 8 weeks to 10½ weeks, to coincide with my next doctor’s
appointment (4/18). My goal is to get the best A1c possible, lowering it from
5.8% to 5.5%, or better. Note, however,
that after 8½ weeks I will no longer be preparing my own meals, and my eating
pattern will include more “dining out.”

Week 2 began uneventfully, with
weight stable and FBGs in the mid-nineties. As the week progressed, my weight
and fasting blood glucose (FBG) both dropped until I was down 3 pounds by
Friday. I gained one back Saturday and 3 more
by Sunday. So, my net for the week was up 1 pound; net for 2 weeks: down 10 pounds.

Saturday was the first day that I
ate outside the home in almost 2 weeks, and I ate too much (2 meals – albeit
“low-carb”), and I drank too much. I don’t regard the 1 lb. gain as much of a
setback, though. The progress I made during the week was not really lost. I am
confident that it will show up on the scale this coming week.

The big news, and the main reason I
am reporting on this week, is what happened to my FBG (and presumably my serum
insulin). My FBGs this week were: 94, 92, 95, 89, 81, 80 & 83. Average:
88mg/dl (4.9mmol/L). Recall that in the 1st week my average was
100mg/dl (5.6mmol/L) and in the week before I began the challenge it was
119mg/dl (6.6mmol/L). With FBGs like this week’s, and a stable blood sugar
during the day, I think my A1c goal is reachable – if I continue to follow this
Low Carb WOE…and with a little help from Metformin. We’ll see.

Other
observations, comments and changes from the original “2 month, 20 pound”
challenge:

●Cooking
for myself has not been as onerous as I thought it would be. In fact, I’m
enjoying it. In the weeks ahead I envision preparing all my meals at home.
Since I always make enough for 2 days minimum, that means only making 2 or 3
meals a week, since I will be fasting 2 days (at least) every week.

●All
day fasting is easy. The first week on the day after a fasting day I had a “snack” (1HB egg) or a “light lunch” (2
HB eggs). This week I did not. And I was not hungry on the fasting day or the day after.

●The
quart of heavy cream lasted only 16-17 days. I use it only in coffee, so, alas,
I put 2oz/day in my cup.

●I
have a new Snack: a few “whole artichoke hearts in water,” and a Light Lunch: ½
can (60g) of “Sell’s Liver Pate.” Also, Bumble Bee is now packing the same wild
caught Brisling Sardines as the King Oscar brand, in the same Baltic Sea
factory, in EVOO (and Hot Jalapeno Peppers), and at a lower price point.

●Virtually
all my suppers are stove top. I love fish, especially cod and similar species.
It’s usually the least costly “fresh” fish in the case, although it may have
been thawed by the fishmonger after having been flash-frozen at sea. I’m going
to check out frozen cod next time I see it. I’m fussy about country of origin.

●My
veal supplier has given up, so I need to find a new source for my veal stew and
veal kidney recipes.

●I loved the tripe dish I made last weekend. The
smallest frozen honeycomb tripe package in the butcher’s case was 2 pounds, so
I made it and had it 4 days in a row. I don’t mind eating the same thing
multiple days in a row; in fact, if I like a dish I made, I look forward to
having it again. (I can’t believe Jason Fung in his “Fructose 3” blog post this
week said he couldn’t imagine someone eating tripe 2 days in a row. Jeez!)

The next report will
catch up with the lag in reporting; it will be at mid-point (5 weeks into) my
new, extended duration. Then, the last report (at 10½ weeks) will have a final
weigh-in, and hopefully an A1c and lipid panel. My doctor is very good at
reviewing the lab report and mailing it to me as soon as his office receives
them.

Sunday, March 5, 2017

As you read this I will be 4 weeks
into my 2-month, 20-pound challenge, but
I write after only 1 week “in.” If you don’t know what prompted me
to do this challenge, read #368 here
to learn my motivation and other particulars. The short report: in the 1st weekI dropped 11 pounds and lowered my FBG
average by 19 points to 100mg/dl. If you’re overweight (as I am) and
prediabetic or a 30-year diagnosed type 2 (as I am), even though theoretically
“in remission,” and that outcome doesn’t pique your interest, you may as well
stop reading.

The “challenge” is to stay on my
current eating pattern 5 days a week and to fast on the other two. My current
eating pattern is coffee with pure stevia powder and 1½ oz of 36% full cream in
the morning. Then, only if I am hungry during the day, to eat either a light
lunch (smoked herring in brine), a “big” lunch (brisling sardines in EVOO), or
a snack (HB egg). My main meal (supper) is a stove-top preparation of cod with
vegetables or a veal stew. Alternatively, I could make tripe in salsa roja or
veal kidney with mushrooms, onions and Marsala.

This week I had cod with tomatoes,
green olives and red pepper flakes Sunday and Monday. Then, I bought 2 pounds
of tripe and made 4 suppers: Wednesday, Friday, Saturday and Sunday. I fasted
on Tuesday and Thursday. On fasting days, besides my morning coffee, I had 1
red wine spritzer at the supper hour, and on the other days I had 2 red wine
spritzers.

Next week (M, W) I will do
different cod preparations (fennel and/or celery in chicken broth). I’ll also
make a romaine salad with mushrooms, hazel nut pieces and shaved Pecorino
Romano, with a vinaigrette.

During the last week I ate a light
lunch (2 HB eggs) the day after the 1st fast day and a snack (1 HB
egg) after the 2nd fast day. Saturday, I had a small can of pork
liver pâté for lunch. There was no other need or occasion to have “lunch” or to
snack during the day or after supper. Saturday night, after attending a jazz
concert, I went “off plan” and stopped at a restaurant on the way home and had
2 stingers in front of a roaring fire.

And that’s all there was to it,
folks. Eleven pounds (okay, half or more water), but the pounds just dropped
off after each full day of fasting. My body maintained a high metabolic rate
(translation: I felt great and had lots of energy and no hunger or cravings).
It did this by transitioning from obtaining energy from the food I ate (S, M,
W, F, S) to obtaining energy from breaking down and burning my body fat on
Tuesday and Thursday.

My perennial goal is to maintain my
FBG average below 100mg/dl (and keep
it low and steady during the day). I hope thus to reduce my A1c from the
current 5.8% to 5.5% or lower. I haven’t seen 5.5% in a few years.

My interim weight goal for this 2
month challenge is to get down to 228 (BMI=32). That’s still considered “obese”
in the BMI chart. So, I can’t derive too much satisfaction from the first week.
I have to persist and be satisfied with a slower pace going forward, spiked
each week no doubt by the 2 full days of fasting.

I have to remind myself that
several years ago I lost 100 pounds in a year (without full-day fasting) by strictly adhering to Bernstein.
But the fasting part is not difficult since you don’t experience hunger or
cravings. As I read in a tweet this week (@SBakerMD), “Beat cravings and you
win.” He’s right, of course. That’s the beauty of a Very Low Carb Ketogenic
Diet. By the way, Dr. Baker eats an all-meat (grass-fed) diet (“zero carb”).

So, that’s the 1st
week’s progress report. I’ll write another next week (2 weeks “in”). I expect
progress to slow a lot, but I am hopeful that my FBG average will drop below 100
and that the weight loss will continue apace.

I fully expect to
continue to feel great and have lots of energy and no hunger, including on fasting days.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.